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Followup to Brothers test results

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Ronald Spane

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May 15, 2012, 4:16:55 PM5/15/12
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Brother had a scan done to his spine in 2008 and the results were a
suspicious area of T12. Since then he has had other scans with the
same result. After having another scan at Sand Lake Imaging a few
weeks ago, he was told the same lesion in T12 plus possibly a couple
others in C4 & C6 . The recommended a Pet Scan with sodium flouride to
confirm. He went to Dattoli Cancer center and had the Pet Scan and the
results were that T12 was probably metsand the other s were not. They
recommended radiation of T12.

He went to his oncologist and he sent him to a radiologist at Moffit
Cancer center and she looked at all his results and told him she don't
radiate untill he has bone pain and she said he didn't have and had a
long time before that would occur. He has been off hormone therapy for
seven months and his PSA just came back as 2.4 which is less than he
had expected. She did suggest he might look into Raium-223 or the
likes.

I suggested along with his oncologist that he should monitor his PSA a
little longer to see a trend before he goes back on hormone therapy.

Ron S.

Alan Meyer

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May 15, 2012, 9:18:23 PM5/15/12
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On 5/15/2012 4:16 PM, Ronald Spane wrote:
> Brother had a scan done to his spine in 2008 and the results were a
> suspicious area of T12. Since then he has had other scans with the
> same result. After having another scan at Sand Lake Imaging a few
> weeks ago, he was told the same lesion in T12 plus possibly a couple
> others in C4& C6 . The recommended a Pet Scan with sodium flouride to
> confirm. He went to Dattoli Cancer center and had the Pet Scan and the
> results were that T12 was probably metsand the other s were not. They
> recommended radiation of T12.
>
> He went to his oncologist and he sent him to a radiologist at Moffit
> Cancer center and she looked at all his results and told him she don't
> radiate untill he has bone pain and she said he didn't have and had a
> long time before that would occur. He has been off hormone therapy for
> seven months and his PSA just came back as 2.4 which is less than he
> had expected. She did suggest he might look into Raium-223 or the
> likes.
>
> I suggested along with his oncologist that he should monitor his PSA a
> little longer to see a trend before he goes back on hormone therapy.
>
> Ron S.

It's always a problem when experts disagree. I can see both points of
view. The doctor at Dattoli probably wanted to kill the cancer while it
was small and before it could become a problem.

The doc at Moffit may have thought that it's possible that this isn't
actually a metastasis, it might just look like one. In that case
radiating it could be a mistake. With a PSA of only 2.4 she has some
possible reason to think that. But the monkey wrench in that theory is
that she's recommending "looking into" Radium-223, also known as
Alpharadin (an injectable radioactive agent that binds to growing bone.)
Why would she recommend that if she thought it might not be a
metastasis? And why would she recommend it if she doesn't think
radiation is appropriate unless there is pain?

But this is all speculation. If I were your brother, I would think hard
about all of this and compile a list of questions like:

What are the advantages and disadvantages of radiation before pain develops?

What are the advantages and disadvantages of beam radiation vs. Alpharadin?

What is the probability that the T12 image is cancer? Is it very high,
high, just a little better than 50%, or really unknown?

What's the downside to radiating (either with external beam or
Alpharadin) if it turns out that there are no mets?

If radiation is used now, can it be repeated later if needed? Or is it
one shot? Is that true of Alpharadin too?

etc.


Ideally, I'd want to get consultations from both docs to answer these
questions. Maybe they would agree to do it by telephone - if your
brother's insurance will allow that.

Even with all of the answers from both docs, it might still be hard to
decide, but that's the way it is. When the experts aren't sure and
don't completely agree, we have to make our own decisions. Of course we
have to do that even when they are sure and agree, but it's a lot easier
then.

Alan

Ronald Spane

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May 16, 2012, 9:51:27 AM5/16/12
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Thanks for the reply Alan.
The problem that my brother has is his doubling rate. It's always been
less than three months since his PSA returned after 7 1/2 years. The
T12 condition is an unknown in that he broke his back in a plane crash
and is (hard wired) so to speak quite a bit. He has no scans prior to
the crash however T12 hasn't changed much if any since then. His
recurrence occured right after the plane crash. Triple hormone therapy
has worked for him but the secound bout saw a slight increase in his
PSA from <.03 to .05 and a slight increase in his testosterone. He
feels that this indicates ADT is starting to loose its effectiveness
and by his reading after the third round he will probably be facing
Chemo or something else. Also his bone density at T12 is T-3.4 and
Z-1.04. It had gotten worse since his first test some time ago.

Ron S.
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